Demographics Form: Fields

[Navigation] Patient > Demographics

[Accordion] Overview

The Demographics form is the primary place to define a patient’s identity and dictates their path through your clinical, administrative, and financial workflows. Rather than acting as a static record, these fields serve as functional triggers that can affect system behavior, eligibility, and reporting, among many other things.

By maintaining accurate demographic data, you ensure that the patient’s journey, from initial intake to active treatment and eventual discharge, is seamless and compliant.

The form is organized into several structured stock tabs.

• Intake
• Demographics
• Parent/Guardian
• Outside Providers/Contacts 
• Insurance
• Financial

[Note] The Parent/Guardian tab will only show for patient records with an Age Category recorded as Child. There is an optional setting to allow it to show for patients with an Age Category of Adult. You can find the setting at: Global Search > Options Form > Preferences > Demographics Form Settings > Display Parent Tab for Adults.

Each tab groups related fields for clarity and consistency. Together, these fields create a complete profile that supports efficiency, compliance, and accurate data reporting.

[Tip] If you see different labels than what is shown in this article (e.g., Patient vs Client), your system may have Custom Labels applied. You can verify and update these by locating "Custom Labels" in the Global Search.

[Accordion]  Toolbar

The Toolbar provides quick access to commonly used actions and related modules associated with the patient record. These buttons can allow you to save changes, manage patient information, and navigate to additional forms directly from the Demographics screen.

[Note] Some of the options listed below may or may not be present based on your system configuration and options you have selected.

1. [[img:save >> lbl:Save]]: Click/Tap to store any changes made to the patient’s demographic information. 

2. [[img:delete >> lbl:Delete]]: Click/Tap to remove the patient record from the system. This button is restricted to users with appropriate permissions.

3. [[img:info >> lbl:Info Release]]: Click or tap to access the Information Release records, a critical compliance module designed to manage and track authorized permissions for sharing protected health information (PHI).

4. [[img:assignment_ind >> lbl:Level of Care]]: Click/Tap to view/assign the patient’s current Level of Care based on the services or treatment intensity required.

5. [[lbl:Scheduling Groups]]: Click/Tap to assign or review the groups used for scheduling appointments, sessions, or services for the patient.

6. [[img:location_away >> lbl:Foster Home Placement]]: Click/Tap to record or review information related to the patient’s Foster Home Placement when applicable.

7. [[img:attach_money >> lbl:Collect Payment]]: Click/Tap to open the payment collection interface and record payments made by the patient or responsible party.

8. [[img:save >> lbl:Save Credit Card Info]]: Click/Tap to securely store the patient’s credit card information for future billing or payment transactions.

9. [[img:merge >> lbl:Merge Current Patient into Another]]: Merge duplicate patient records into one.

10. [[img:admin_meds >> lbl:Medication Listing]]: Click/Tap to access the 'Patient Summary: Medications' feature and add/view/manage medication records.

11. [[lbl:Completed Paperwork]]: Click/Tap to view documents or forms that the patient has already completed within the system.

12. [[img:chevron_forward >> lbl:More]]: Click/Tap to navigate to additional forms or modules related to the patient that are not displayed directly on the toolbar.

[Accordion] Record Details

The Record Details group box provides audit-level information about the Demographics record. It does not collect clinical or identifying data; instead, it displays system-generated tracking information reflecting the most recent update to the record.

1. Last Modified By: The Last Modified By field provides an essential layer of accountability and data integrity within the patient record. By automatically tracking which staff member performed the most recent update, the system maintains a transparent audit trail for every demographic change.
2. Last Modified On: The Last Modified Date/Time field provides a precise, timestamp of the most recent activity on a patient’s record. It serves as the primary chronological anchor for data integrity, ensuring that every administrative or clinical update is anchored to a specific moment.

[Accordion] Tab: Intake

[Note] You can make a number of the fields in the Demographics form required, not required, or conditionally-required. Users with Administrative Privileges can see the available settings at: Global Search > Options Form > Preferences: Demographics Form Settings.

The Intake tab is the starting point for every patient in the system. It tracks how a person first contacts your clinic, how they are categorized, and who is in charge of their care.

1. Intake:
   • Type: By selecting either Intake or Patient, you define the individual’s current stage in the clinical lifecycle and unlock the appropriate tools for that stage
   • Age Category: Select whether the individual is classified as a Child or Adult. This setting can affect form behavior (e.g., the Parent/Guardian tab is displayed only when the “Display Parent Tab for Adults” setting is enabled in the Options form)
   • Status: Select the Status to indicate whether the individual is Active or Discharged (discharge-related fields are enabled only when Status is set to Discharged)
   • Intake By: Select the staff member entering the intake record
   • Initial Contact Method: Select the method used by the individual to initiate contact, for example Patient Portal, Phone, etc. (available options are set at Utilities > Maintenance > Contact Method)
   • Initial Contact Name: Enter the name of the person who initiated contact, if different from the patient
2. Key Dates:
   • Date Entered (required):  Select/Enter the date and time when the Demographic record was created in the system
   • Date Packet Sent: Select/Enter the date and time when the intake paperwork was sent before service delivery
   • Date Packet Returned: Select/Enter the date and time when the intake paperwork was returned
   • Date of Contact for Appointment: Select the date and time when the individual was first contacted to schedule an appointment (cannot be later than the first appointment date)
   • Date of Intake Appointment: Select/Enter the date and time of the initial intake appointment
   • Date Admitted: Select/Enter the date and time when the individual is formally admitted (when entered, the 'Type' must be set to 'Patient')
   • Date Assigned to Follow-up Clinician: Select the date and time when the case was assigned to an ongoing clinician
   • Discharge Date: Select the date and time when the services were formally concluded
   • Successfully completed treatment at discharge: Check the box to indicate that the treatment was successfully completed
   • Discharge Status: Describes the outcome or reason associated with discharge

[Note] "Discharge Date", "Successfully completed treatment at discharge", and "Discharge Status" fields are enabled only when the Status is set to Discharged.

3. Assignments:
   • Intake Service: Select the service associated with the intake (options can be configured through Utilities > Maintenance > Intake Service Input)
   • Intake Clinician: Select the clinician responsible for completing the intake
   • Follow-up Clinician: Select the clinician assigned to ongoing care after intake (may also auto-populate compliance records based on system settings)
   • Intake Disposition: Select the outcome of the intake, such as Administrative Closure or Diagnostic Evaluation (configured through Utilities > Maintenance > Disposition Input)
   • Primary POS (required): Select the primary service location where treatment will occur
   • Diagnosis Type: Select the diagnosis input type as configured at Utilities > Maintenance > Diagnosis Type
4. Referral:
   • Heard About Us From: Select the source through which the individual learned about the organization (configured at Utilities > Maintenance > Heard About Us From)
   • Referral Source: Identify the referral entity (configured at Utilities > Maintenance > Referral Source)
   • Referred By: Enter the name of the person referring the patient for treatment
   • Referral Phone: Enter the phone number of the referring individual
   • Referral Email: Enter the email address of the referring individual
   • Referral Agency: Enter the organization associated with the referral
   • Reason for Referral: Records the reason(s) services are being sought (values may be entered manually or selected from a configured list at: Utilities > Maintenance > Reason for Referral)
5. Mental Health/ Chemical Dependency:
   • Mental Health: Check this box to indicate that the patient is receiving or referred for mental health services
   • Chemical Dependency: Check this box to indicate that the patient is receiving or referred for chemical or substance use treatment
   • Primary Module: Identify the main service area under which the patient/intake will receive treatment or be tracked in the system. Selecting the correct module is the first step in ensuring the system displays the right paperwork, clinical tools, and billing rules for that specific type of care
6. Miscellaneous:
   • Hospital Number: Enter/Generate the patient’s global chart number: This number is displayed on all generated paperwork
   • Additional #: Enter a supplementary identification number
   • Family ID #: Enter/Generate a unique identifier used to link related family members within the system, allowing tracking of intakes/patients from the same family
   • Case Worker: Enter the name of the assigned case worker
   • Med-Assist. Opioid Therapy: Select whether medication-assisted opioid therapy applies
   • Patient Characteristics: Select the patient characteristics from the dropdown

7. Patient Group:
   • Patient Group: Primary organizational grouping assigned to the individual
   • Patient Group ID # Internal identifier associated with the selected Patient Group
   • Additional Patient Groups: Additional Patient Group assignments for reporting or tracking
8. Notes: Enter additional intake-related information not captured in structured fields

[Accordion] Tab: Demographics

The Demographics tab contains the core identifying and personal information for the individual’s record. It serves as the foundation of the profile and is typically the first section completed when creating or updating a record.

1. Patient Details:
   • Last Name (required): Enter the patient’s last name as it appears on official identification
   • First Name (required): Enter the patient’s first name as it appears on official identification
   • Middle Name: Enter the patient’s legal middle name, if applicable
   • Preferred: The name the patient prefers to be called, if different from their legal name
   • Alias: An alternate name or nickname a patient may use, different from their legal name
   • Suffix: Enter the name suffix associated with the patient (e.g., Jr, Sr)
   • Sex (required): Enter the patient’s recorded biological sex for legal, clinical, or billing purposes
   • SSN (required):  Enter the patient’s Social Security Number if the patient chooses to provide it (if the patient declines, enter 999-99-9999 instead)
   • Date of Birth (required): Enter the patient’s date of birth
2. Address:

   • Address Unknown: Check this box to indicate that the patient’s current address is not known

   • Homeless: Check this box to indicate that the patient currently does not have stable housing

   • Address Line 1 (required): Enter the primary street address, including house or building number and street name

   • Address Line 2: Enter additional address details such as apartment, suite, or unit number

   • City (required): Enter the city of the patient’s current residence

   • State (required): Enter the state or province of the patient’s current residence

   • ZIP (required): Enter the postal or ZIP code associated with the patient’s address

   • County of Residence: Select the county in which the individual currently resides from the dropdown

   • County of $ Responsibility: Select the county that holds financial responsibility for the individual’s services from the dropdown

   • Country of Birth: Select the country in which the individual was born

3. Contact Information:
   • Phone Number: Enter the primary contact phone number for the patient (the number in this field will be used to when Voice Call Appointment Reminders are enabled for the patient)
   • Other Phone: Enter the secondary phone number for alternate contact
   • Cell Phone: Enter the patient’s mobile phone number (the number in this field will be used to when SMS Appointment Reminders are enabled for the patient)
   • Email Address: Enter the patient’s email address
   • Preferred Contact Method: The patient’s preferred method of communication (e.g., phone, email, text)
   • Suppress Appointment Reminders: Check the box to indicate that the individual should not receive Appointment Reminders
   • Time Zone: Select the patient’s local time zone
   • Contact Notes (Patient Availability, etc.): Enter notes regarding best times to contact the patient or communication preferences
   • Household Information: Enter information about the patient’s living situation, including who resides in the home and any household factors that may impact care, safety, or support
   • Instructions Regarding Directions and Scheduling: Enter special instructions related to appointment scheduling or directions

4. Other Details:
   • Sexual Orientation: Select the patient’s personal identification of their sexual orientation
   • Gender Identity: Select the patient’s personal identification of their gender
   • Pronouns: Select the pronouns the patient prefers others to use when addressing or referring to them
   • Employer: Select the organization, company, or business where the patient is currently employed
   • Race: Select the patient’s self-identified racial category
   • Race Other: Select additional or alternative racial identification provided by the patient
   • Ethnicity: Select the patient’s ethnic background (e.g., Hispanic or Latino, Not Hispanic or Latino)
   • Citizenship Status: Select the patient’s legal citizenship or residency status
   • Marital Status: Select the patient’s current marital status
   • Primary Language: Select the primary language the patient prefers for communication

5. Smoking History:

   • Smoking Status: Indicates whether the patient currently smokes, formerly smoked, or never smoked

   • Offered Cessation Counselling: Indicates whether smoking cessation counseling was offered

   • Reason for Not Offering: Select the reason why cessation counseling was not offered

   • Comments: Enter additional notes regarding the patient’s smoking history

6. Miscellaneous:

   • Advanced Directive: Indicates whether the patient has a legal document outlining their healthcare decisions if they become unable to communicate

   • Has a Disability: Indicates whether the patient has a physical, mental, or developmental disability

   • Requires Interpreter: Check this box to indicate that the patient requires language interpretation services

   • Requires Transportation: Check this box to indicate that the patient requires assistance with transportation to appointments

[Accordion] Tab: Parent/Guardian

[Note] The Parent/Guardian tab is typically only visible only when the individual is classified with an Age Category of 'Child' on the 'Intake' tab. However, there is an optional setting to allow it to show for patients with an Age Category of Adult. You can find the setting at: Global Search > Options Form > Preferences > Demographics Form Settings > Display Parent Tab for Adults.

1. General Information: Enter high-level family and household context, including parental marital status and details about the number of children in the family, home, and school. School-related information, such as school name, district, and grade level, is also captured here. 
2. Father's Information: Enter identifying, demographic, contact, educational, and occupational information for the father. 
3. Mother's Information: Enter identifying, demographic, contact, educational, and occupational information for the biological mother. 
4. Guardian Information: This section is used when a legal guardian other than the biological parents is responsible for the child. Enter identifying and contact details for both primary and secondary guardians, along with their relationship to the child.

[Accordion] Tab: Outside Providers/Contacts

1. Primary Care Physician Information: Enter the name and contact details of the patient’s primary medical provider.
2. Outside Mental Health Provider: Enter details of any mental health professional or agency providing services to the patient outside your organization. 

[Note] Add a mental health provider from the Outside MH Provider Details Maintenance Form.

3. Pharmacy: Enter the pharmacy details used by the patient for prescriptions.

[Note] If you have licensed the ePrescribing Integration you will select the patient's pharmacy from within the ePrescribing Portal rather than entering it in the Outside Providers/Contacts tab.

4. Emergency Contact Info: Enter details to be notified in case of an emergency. This ensures that appropriate parties can be reached quickly when urgent situations arise.
5. [[img:playlist_add >> lbl:External Contacts]] Add and maintain records of individuals or agencies connected to the patient’s care, support system, or professional network, including their contact details and relationship to the patient.

[Accordion] Tab: Insurance

[[img:playlist_add >> lbl:Manage Insurers]] Click/Tap to open the Manage Insurers screen to add, edit, or configure insurance companies in the system. 

[Note] You will first need to save a newly created Demographic record before opening Manage Insurers.

1. Insurance Policy Details:
   • Priority: Indicates the order of this insurance coverage (e.g., Primary, Secondary, Tertiary)
   • Coverage Start Date: The date the insurance coverage becomes active
   • Coverage End Date: Select/Enter the date on which the insurance coverage expires or is terminated. (leave blank if coverage is ongoing)
   • Company: Select the name of the insurance company providing coverage (entries are configured at Utilities > Maintenance > Insurance Plan Input)
   • Policy/Member ID Number: Enter the insurance identification or member ID number found on the patient’s insurance card
   • Group Number: Enter the insurance group number associated with the policy (typically provided by the employer or insurance provider)
   • Policy Holder: Name of the individual who holds the insurance policy
   • Insured's Employer: Employer of the policy holder
   • Insured's DOB: Enter the policy holder’s Date of Birth
   • Last Qualification: The most recent date the insurance coverage was verified
   • Next Requalification: The next scheduled date for insurance verification (may be automatically calculated based on insurer settings configured through Maintenance > Insurance Plan Input)
   • Coverage Cap: Enter the maximum coverage amount allowed under the insurance policy 
   • Individual Copay: Enter the patient’s individual copay amount
   • Group Copay: Enter any group copay amount applicable under the policy
   • Annual Deductible: The amount a patient must pay out of pocket for covered services each year before their insurance begins to pay
   • Annual Deductible Met: The portion of the annual deductible the patient has already paid toward covered services during the current plan year
2. Patient Relationship to Insured:
   • Patient Relationship to Insured (required): Indicates the patient’s relationship to the policy holder (e.g., Self, Spouse, Child). Required when the policy holder is not the patient
   • Insured's Information (If Other or Spouse): Enter additional details of the insured individual when the policy holder is not the patient. The fields become active when the 'Patient Relationship to Insured' is marked as 'Other' or 'Spouse'

[Accordion] Tab: Financial

1. Responsible Party: Identifies who is financially responsible for the patient's services. 
2. If "Other" or "Spouse" Complete Section: Captures the name, address, phone, and email details of the responsible party when Other or Spouse is selected. These fields remain inactive (greyed out) until one of those options is chosen in the Responsible Party section.
3. Reduced Fee:
   1. Not Billable for Any Services: Indicates that the patient should not be charged for the services rendered. This will set Billable Status on Patient Contacts- Appointment records to Non-Billable.
   2. Reduced Fee: Marks that the patient is eligible for a reduced fee schedule.
   3. Gross Income $: Stores the patient gross income. 
   4. People in Family: The total number of individuals in the household, used with income to determine reduced fee eligibility.
4. Accident Information (For Worker's Comp Claims): Records details of a work-related accident needed for workers’ compensation claim processing.
5. Additional Information:
   • Signature on File: Indicates the patient’s signed authorization is on file, required for HCFA claim submission.
   • Financial Assignment: Confirms that the patient has assigned insurance benefits to the practice, allowing the organization to receive payments directly from the insurer.
6. Insurance Type Code (Used for Secondary Claims): Specifies the type of insurance for processing secondary claims.
7. Reduced Fee Summary: Shows a table summarizing the patient’s reduced fee settings across services, credentials, and schedules.

[Accordion] Best Practices for Preventing Duplicate Record Creation

1. Search Before Creating a Record
Always search the system using the patient’s name, date of birth, or other identifiers before creating a new record.

2. Use Multiple Search Criteria
If the first search does not return results, try variations such as partial names, alternate spellings, or date of birth.

3. Verify Patient Information
Confirm key details like full name, date of birth, and address with the patient to ensure you are selecting the correct existing record.

4. Check for Similar Records
Review search results carefully for similar names or matching birthdates that may already belong to the patient.

5. Follow Standard Naming Conventions
Enter names consistently (for example, legal name rather than nicknames) to reduce the chance of duplicate entries.

6. Update Existing Records Instead of Creating New Ones
If patient information has changed, update the existing record rather than creating a new one.

7. Use Alerts or System Warnings
Pay attention to any system prompts that indicate a possible duplicate record before saving a new patient.

[Accordion] FAQs

[Q] Why are the Discharge Date and Discharge Status fields greyed out?

[A] These fields activate only when Status is changed to Discharged, and you must have the appropriate permissions to make this change.

[Q] Why are the Responsible Party contact fields inactive in the Financial tab?

[A] The If “Other” or “Spouse” Complete Section becomes editable only when "Other" or "Spouse" is selected as the Responsible Party.

[Q] Why can’t I enter a Discharge Date?

[A] The Discharge Date field is locked until the patient’s Status is changed to Discharged.

[Q] Why does Time Zone matter?

[A] The Time Zone setting ensures that appointment times, reminders, and telehealth sessions are sent and displayed correctly based on the patient’s local time.

[Q] How do I record that a guardian or external contact is no longer involved in the patient’s care?

[A] Open the contact’s record in the Outside Providers/Contacts tab and uncheck Is Active. Then enter the Date Removed and save.

[Q] How do I enter multiple insurance policies for a patient?

[A] Use the Insurance Tab to enter each policy and assign a Priority (Primary, Secondary, Tertiary) to determine the billing order.

[Q] What happens if required fields are left blank in the Demographics form?

[A] The system will prevent you from saving the record until all required fields are completed. Always make sure to fill in these mandatory fields to avoid errors and ensure the patient’s information is accurate.

[Q] What should I do if a patient’s insurance changes during treatment?

[A] Add the new insurance policy in the Insurance tab and set its Priority (Primary, Secondary, etc.) as needed. Make sure the Coverage Start and End Dates are correct so that claims are processed for the proper coverage period.

[Accordion] Related Articles

Step-By-Step Guide to Adding A Patient

Configuring your Demographics Form

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